Provider Demographics
NPI:1891231353
Name:INTEGRATED WOMEN'S HEALTH LLC
Entity Type:Organization
Organization Name:INTEGRATED WOMEN'S HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRESA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLACE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:504-309-2576
Mailing Address - Street 1:110 BELLEMEADE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:LA
Mailing Address - Zip Code:70056-7142
Mailing Address - Country:US
Mailing Address - Phone:504-309-2576
Mailing Address - Fax:504-309-2589
Practice Address - Street 1:110 BELLEMEADE BLVD STE A
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-7142
Practice Address - Country:US
Practice Address - Phone:504-309-2576
Practice Address - Fax:504-309-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP07277363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty